Editorial
Transfus Med Hemother 2015;42:72–73
DOI: 10.1159/000381729
Patient Blood Management: It Is Time to Streamline
Targeted Therapy Options
Peter Schlenke a Donat R. Spahn b
a
Department of Blood Group Serology and Transfusion Medicine, Medical University Graz, Graz, Austria;
b Instituteof Anesthesiology, University and University Hospital of Zurich, Zurich, Switzerland
By searching in the U.S. National Library of Medicine in March
2015, surprisingly less than 100 articles titles contain the term ‘pa-
tient blood management’. Nevertheless, patient blood management
has been received much attention worldwide in recent years, re-
sulting in hospital-based or national campaigns to educate physi-
cians and nurses in the three-pillar concept of patient blood man-
agement [1]. Like many other medical procedures, patient blood
management aims at improving the patients’ outcome and safety.
By then, everything seems to be business as usual, and obviously
one might not imagine that the topic is highly charged both politi-
cally and emotionally. All stakeholders in healthcare need to over-
come the ongoing controversy about the benefit-risk ratio of blood
transfusions.
Patient blood management is defined as evidence-based multi-
disciplinary approach to preoperatively screen and treat patients
for anemia, to minimize intraoperative blood loss by elaborating
meticulous surgical techniques, individualized goal-directed coag-
ulation management and cell salvage, and finally to harness the pa-
tient’s physiological capacity for compensation of low hemoglobin
levels prior to application of allogeneic blood transfusions [1, 2].
Compared with initiatives for optimal blood use with their motto
‘transfusion of the right unit of blood to the right patient at the right
time’, it is obvious that patient blood management is a broader
concept covering many more issues.
The evidence-based medicine approaches are well accepted by
the vast majority of scientists and physicians as it facilitates the
individual decision making for diagnosis, investigation, and/or
therapy by emphasizing different levels of evidence from well-de-
signed and well-conducted randomized clinical trials, systematic
reviews, and meta-analyses. Patient blood management is strictly
based on the principles of evidence-based medicine. Therefore, it
promotes turning away from purely empirical knowledge and fos-
ters the conduction of further clinical trials with special patient
subsets, e.g. patients with septic shock [3] and traumatic brain in-
jury [4], The results of these two studies are in line with the overall
© 2015 S. Karger GmbH, Freiburg
1660–3796/15/0422–0072$39.50/0
Fax +49 761 4 52 07 14
Information@Karger.com Accessible online at:
www.karger.com www.karger.com/tmh
Received: March 16, 2015
Accepted: March 18, 2015
Published online: March 31, 2015
statement of a recently published Cochrane review that has evalu-
ated the data of 19 randomized clinical trials with a total of 6,264
patients involved [5].
The multidisciplinary approach describes teamwork of multiple
disciplines to ‘redefine problems outside of normal boundaries and
reach solutions based on a new understanding of complex situa-
tions’ (http://en.wikipedia.org/wiki/Multidisciplinary_approach).
This definition of the free encyclopedia Wikipedia perfectly fits
with the challenges of patient blood management. To increase the
overall effectiveness specialists of as many disciplines as possible
need participating in patient blood management programs. This
includes anesthesiologists, surgeons of different specialties, inten-
sive care physicians as well as specialists in transfusion medicine
and hemostaseology. Furthermore, these programs need to be ex-
panded into nonsurgical patients such as those of internal medi-
cine, oncology, and pediatrics.
Obviously, for successfully implementing patient blood man-
agement bedside physicians are the primary target persons in order
to avoid unnecessary allogeneic blood transfusions or their inap-
propriate application. They should be particularly educated in up-
dated transfusion policies and alternative interventions such as the
preoperative treatment of anemia by intravenous iron and/or
erythropoietin. Anemia is an independent risk factor for higher
morbidity and mortality [6, 7]. Therefore, patient blood manage-
ment does not focus simply on the adherence of transfusion trig-
gers for specific patient cohorts, such as a threshold of 7 or 8 g/dl
[8], but aims at the screening, monitoring, and treatment any kind
of mild to severe anemia prior to surgical intervention and/or dur-
ing nonsurgical treatments if indicated [2].
Considering the results obtained from a variety of randomized
clinical trials, it is time to streamline targeted therapy options ei-
ther to correct iron deficiency anemia in patients who undergo sur-
gery or to identify patients who are at risk for complications such
as myocardial and cerebral ischemia due to severe anemia and thus
will benefit from allogeneic blood transfusions.
Prof. Dr. Peter Schlenke
Department of Blood Group Serology and Transfusion Medicine
Medical University Graz
Auenbruggerplatz 48, 8036 Graz, Austria
Peter.Schlenke@klinikum-graz.at
 Blood donation establishments and specialists in the field of
transfusion medicine should be aware that the paradigm shift to a
more restrictive use of allogeneic blood or its strict avoidance, if
suitable alternatives are available, is already underway in health re-
search and healthcare nowadays [2]. We do well to strengthen our
professional ethics to cure patients or to ameliorate illnesses and
injuries to our best knowledge. So, voluntary blood donations and
their state-of-the-art use is rather an issue of quality than of
quantity.

References
1 Williamson LM, Devine DV: Challenges in the manage-
ment of the blood supply. Lancet 2013; 381: 1866–1875.
2 Spahn DR, Goodnough LT: Alternatives to blood
transfusion. Lancet 2013; 381: 1855–1865.
3 Holst LB, Haase N, Wetterslev J, et al: Lower versus
higher hemoglobin threshold for transfusion in septic
shock. N Engl J Med 2014; 371: 1381–1391.
4 Robertson CS, Hannay HJ, Yamal JM, et al: Effect of
erythropoietin and transfusion threshold on neuro-
logical recovery after traumatic brain injury: a ran-
domized clinical trial. JAMA 2014; 312: 36–47.
5 Carson JL, Carless PA, Hébert PC: Transfusion thresh-
olds and other strategies for guiding allogeneic red
blood cell transfusion. Cochrane Database Syst Rev
2012; 4:CD002042.
6 Musallam KM, Tamim HM, Richards T, Spahn DR,
Rosendaal FR, Habbal A, Khreiss M, Dahdaleh FS,
Khavandi K, Sfeir PM, et al: Preoperative anaemia and
postoperative outcomes in non-cardiac surgery: a ret-
rospective cohort study. Lancet 2011; 378: 1396–1407.
7 Baron DM, Hochrieser H, Posch M, Metnitz B, Rhodes
A, Moreno RP, Pearse RM, Metnitz P, European Surgi-
cal Outcomes Study Group for the Trials Groups of the
European Society of Intensive Care Medicine, the Euro-
pean Society of Anaesthesiology: Preoperative anaemia
is associated with poor clinical outcome in non-cardiac
surgery patients. Br J Anaesth 2014; 113: 416–423.
8 Hébert PC, Carson JL: Transfusion threshold of 7g per
deciliter – the new normal. N Engl J Med 2014; 371:
1459–1461.

Patient Blood Management: It Is Time to Transfus Med Hemother 2015;42:00–00 73

Streamline Targeted Therapy Options